Health insurers will work in 2006 to build on this year’s efforts in Congress, to avoid partisan politics and to continue working to make the health care system more accessible to consumers.
Perhaps the most pressing issue for the health industry in Congress, according to Janet Trautwein, executive vice president and CEO of the National Association of Health Underwriters, is the promotion of long term care partnerships.
“This is one of the first pieces of legislation in a long time that will help people who have moderate incomes and depend on Medicaid avoid having to spend down all of their assets,” she says. “It provides an incentive for people to plan privately for their long term care expenses but retains the safety net.”
These partnerships allow consumers to purchase a basic LTC plan and then when the policies’ benefits run out, go on Medicaid without spending down all their personal assets. Currently the partnerships exist only in four states–New York, Connecticut, California and Indiana–but Trautwein notes that language in the current budget reconciliation legislation would allow other states to establish their own.
Many other states, she says, already have begun laying the groundwork for partnerships and have passed legislative resolutions supporting the concept. “They’re going to create, on a pretty short order, these partnerships,” she says.
The budget reconciliation is currently in conference, meaning that members of the House and Senate are negotiating between their separate versions to craft a final bill to send to the White House, but Trautwein says it appeared the partnership language is “not likely to be removed” from the final product.
Karen Ignagni, president and CEO of America’s Health Insurance Plans, notes that the budget reconciliation talks may linger into 2006 and says AHIP would continue its efforts on passing the bill “into next year.”
Additionally, Trautwein says she expects to see legislation that makes minor technical adjustments to health savings accounts to make them “more user-friendly,” which she says shows the current trend toward a more active role for consumers in their health care choices. “Consumer-directed health care is not going away,” she says. “There’s still a whole lot of interest in it.”
Ignagni says AHIP would work to enact changes in HSAs that would help lower costs by classifying “maintenance drugs” such as asthma medication as preventative medicine and eliminating the need for consumers to pay a deductible for them.
Trautwein says she also expects to see action on a bill introduced in November by Sen. Michael Enzi, R-Wyo., that would increase regulatory uniformity for health insurance from state to state. NAHU supports “the idea of the bill,” Trautwein says, but has some concerns about its specific language.
The bill would, however, help ease the group’s concerns over association health plans by establishing a level regulatory playing field between AHPs and other health insurance products.
“Prior to this, you wouldn’t have a level playing field,” Trautwein says.
There are, however, some areas of concern for health insurers. Although Ignagni says she believes Congress will consider offering tax support for people who are unable to afford their employer’s health plans or whose employers don’t offer coverage, Trautwein does not believe Congress will make any major moves toward helping to lower the number of uninsureds, as the cost has become too high.
“I don’t see any more money coming from Congress” for promoting more insurance coverage, she says. “I just don’t see the money for that.”
Additionally, Trautwein says there is growing concern over the concept of capping the tax exemption for employer-sponsored health benefits. Employer groups, she says, are “up in arms” over the idea, but it is receiving some consideration from conservative groups and even members of Congress as a way of reducing government expenses and increasing tax revenue.
“There are big players in Congress looking at this,” she says, including House Ways and Means Committee Chairman Bill Thomas, R-Calif.
Trautwein says the concern is the idea could gain momentum from conservative lawmakers who feel confident they can sell it to their constituents as a measure against high-end “Cadillac” health plans.
“Some politicians believe they can very easily explain that this is a great idea and that they can get by on it,” she says.
While the notion of discouraging excessive plans may have merit, she says, the concept of capping the tax benefit fails to take into account that there are different reasons a health plan may have a high cost.
“Government capping of the tax exemption doesn’t account for the fact that some people have different reasons for having high costs,” she says, noting that small companies may have higher costs, or those with a large number of older workers.
“Caps are not addressing that issue at all,” Trautwein says.
Of course, in Washington, these issues must be viewed with an eye on the election cycle, and 2006 figures to be a big year with many important congressional elections. Trautwein says she hopes the cap issue would remain outside the electoral debate.
“It would be better if we had this discussion in a reasonable year, not this next year,” she says. “People we normally think of as reasonable think this is a good idea.”
In general, she says, NAHU works to keep its issues solidly in the middle between the two parties, although sometimes an issue is politicized by one party or the other.
“We try really hard not to do that,” Trautwein says, “but sometimes you have things where it’s just one side.”
Typically, however, she says NAHU manages to keep its efforts politically neutral, working with members on both sides of the aisle. “You try to take the politics out of it,” she says. “If you try a little, you mitigate it a bit.”
One example is the LTC partnership language, which she says has “broad bipartisan support.”
Ignagni also notes the importance of working to keep issues separate from politics, saying “step one is to make sure that you have very high-quality policy work” that both sides of the aisle can understand and use.
While she acknowledges that “there’ll be the usual election year positioning,” in 2006, she remains confident the elections would not disrupt the health insurance industry’s agenda.
For the health insurance industry as a whole, Ignagni says one of the main goals should be to build upon its recent successes in reducing costs. Rate increases will be at their lowest in four years, she notes, and the industry should work to show “how we have marshaled our tools and techniques” to bring increased value to customers.
“We’ve had reduced costs; that’s a definite trend,” Ignagni says, adding that the industry must work to bring those same tools to other areas, such as quality and transparency.
The initiative to increase transparency, she says, is the “prism” through which AHIP will view other issues as it works toward “giving consumers the information they need to navigate the health insurance world.”
Part of that effort, she says is establishing the measures of quality used in evaluating health care. AHIP is a member of the Ambulatory Care Quality Alliance, a consortium of physician and health care groups working “to reach a consensus around what the elements are that should be measured to determine quality,” Ignagni says. This group already has established a number of measures that can be used for evaluating primary care, she says, and is working to develop standards for specialties and sub-specialties.
In addition, Ignagni says ACQA is also working “to collaborate as to what goes into a personal health record,” so that records will be more easily understood between different health care facilities and providers. She compares this effort to those undertaken by banks as they implemented the technology used in ATMs.